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Step2CK > Neuro and optho Uworld > Flashcards

Neuro and optho Uworld Flashcards

1
Q

lacunar infarct causes what

A

pure unilateral motor impairment
pure sensory stroke
no visual field abnormalities

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2
Q

middle cerebral a occlusion signs

A

contra somatosensory loss contra motor loss
conjugate eye deviation toward infarct side
homonymous hemianopia
aphasia (if left hemisphere aka dominant)
hemineglect of the non dominant hemisphere (right)

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3
Q

anterior cerebral artery occlusion signs

A

contra somatosensory and motor deficit
mainly in lower legs
dyspraxia, emotional disturbances and urinary incontinence

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4
Q

most common cuases syringomyelia

A

spinal cord injury and arnold chiari malformations

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5
Q

what nerve controls hip and knee flexion

A

femoral

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6
Q

what causes intracranial HTN

A

trauma, space occupying lesions, hydrocephalus, impaired CNS venous outflow and idiopathic(pseudotumor cerebri)

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7
Q

patient with otitis and now mastoiditis, next step?

A

Brain CT to look for brain abscess, likely temporal

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8
Q

what type of neuronal signs in ALS

A

upper and lower

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9
Q

symptoms and signs of friedreich ataxia

A

necrosis and degeneration cardiac muscle fibers, myocarditis, myocardial fibrosis, cardiomyopathy
T wave inversion

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10
Q

T wave inverison alone is suggestive of what pathologie

A

myocarditis, MI, old pericarditis, Myocardial contusion and dig toxicity

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11
Q

what can cause carotid artery dissection

A

penetrating trauma
fall with object in mouth
neck maniputlation (yoga and sports)

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12
Q

personality change means that what lobe is affected

A

frontal

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13
Q

CT/MRI findings glioblastoma

A

butterfly appearance with central necrosis

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14
Q

what happens with prolonged seizures

A

cortical laminar necrosis

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15
Q

pronator drift is sensitive and specific for what

A

UMN injury

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16
Q

main risk factory for CP

A

prematurity

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17
Q

phenytoin use during pregnancy, child will have

A

fetal hydantoin syndrome

midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay

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18
Q

Aminoglycoside adverse effect

A

ototoxicity

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19
Q

what is used for absence seizures

A

ethosuximide and valproic acid

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20
Q

shakey baby syndrome will cause what inside

A

shearing subdural veins and retinal hemorrhages

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21
Q

course of presentation for intracerebral hemorrhage

A

focal neurologic symptoms early

later develop nausea and vomiting from ICP

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22
Q

brain death, still have preserved what function sometimes

A

DTRs

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23
Q

what dementia can cause visual hallucinations

A

lewy body

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24
Q

multuple circumscribed lesions on both sides of brain along junction grey and white matter

A

secondary mets

likely lung or melanoma

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25
Q

solitary brain masses are usually from what CA

A

breast, colon or renal cell

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26
Q

what is primidone used for

A

essential tremor

it converts into phenylethylmalonamide and phenobarbital

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27
Q

primidone may precipitate what

A

acute intermittent porphyria

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28
Q

how does acute intermittent porphyria present

A

abdominal pain, neuro and psychiatric abnormalities

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29
Q

how do Dx acute intermitten porphyria

A

check for urine porphobilinogen

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30
Q

Tx viral conjunctivitis

A

cool moist compresses

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31
Q

immediate manamgent of central retinal artery occlusion

A

ocular massage and high flow O2

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32
Q

Tx exertional heat stroke

A

immersion in ice water after stabilized with IV fluids

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33
Q

what are signs of uncal herniation

A

compression of contralateral crus cerebri causes ipsi hemiparesis
compression ipsi occulomotor nerve cause mydriasis ptosis and down out gaze
compression ipsi posterior a causes contralateral homonymous hemianopsia
compression reticular formation will cause LOC and coma

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34
Q

transtentorial uncal herniations can be secondary to what

A

space occupying lesions like epidural bleed

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35
Q

cushings reflex

A

HTN bradycardia and respiratory depression all from increased ICP

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36
Q

findings on MRI of meningioma

A

extra-axial well circumscribed and homogenously enhancing dural based mass

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37
Q

signs of niemann pick

A

loss of motor milestones, hypotonia, feeding difficulties cherry red macula
!! different the tay sachs because also will have hepatosplenomegaly and Areflexia
tay sachs has hyperreflexia

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38
Q

niemann pick is deficiency in what

A

spingomyelinase

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39
Q

next step for enlarging head circumference in child

A

CT of brain

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40
Q

complications of prematurity

A 
RDS
PDA
bronchopulmonary dysplasia
intraventricular hemorrhage
necrotizing enterocolitis
retinopathy
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41
Q

NPH is due to

A

decreased CSF absorption

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42
Q

how to check for phenylketonuria

A

quantitative aa analysis

or tandem mass spectrometry

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43
Q

signs phenlyketouria

A

severe intellecual disability
seizures
musty odor
hypopigmentation involing hair skin eyes and brain nuclei

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44
Q

incidence of Intraventricular hemorrhage is inversely proportional to what

A

birth weight

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45
Q

first line for migraines assoc with vomiting

A

prochloperazine (antiemetic)

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46
Q

presence of EBV DNA in CSF

A

primary CNS lymphoma

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47
Q

MRI of CNs lymphoma

A

ring enhancing mass that is solitary and periventricular

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48
Q

wallenberg syndrome

A

vertigo, fall to side of lesion
diplopia and nystagmus
ipsi limb ataxia

abnormal facial sensation or pain
loss of pain and temp ipsi face contra trunk and limbs

dysphagia and aspiration
hoarseness
ipsi horners
intractable hiccups
lack of automatic respiration
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49
Q

what artery occlusion causes wallenbergs

A

intracranial vertebral artery

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50
Q

side effects trihexyphenidyl

A

anticholinergic: blurred vision, constipation, vomiting

headache, dizziness, tachycardia

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51
Q

Tx myasthenic crisis

A

plasma exchange

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52
Q

CMV retinitis signs

A

yellow whiteish patches retinal opacification and retinal hemorrhages

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53
Q

Tx CMV retinits

A

ganciclovir or foscarnet

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54
Q

presentation sturge weber

A

focal or generalized seizures, mental retardation and port wine stain along trigeminal nerve
can have hemianopia, hemiparesis and hemisensory disturbances

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55
Q

intracranial calcifications resembling tramline

A

sturge weber

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56
Q

bilateral loss central vision

A

macular degeneration

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57
Q

HTN hemorrhage with contralateral hemiparesis and hemianesthesis and conjugate gaze deviation to side of lesion

A

putamen (basal ganglia bleed) because affects internal capsule

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58
Q

effects of parietal hemorrhage

A

contralateral hemi sensory loss

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59
Q

Cauda equina syndrome

A

compression spinal nerve roots from metastatic prostate CA
can lose anal sphincter innercation, lose parasympathetic to bowel and bladder
LMN Sx

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60
Q

conus medullaris syndrome

A

sudden onset with severe back pain and have hyperreflexia

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61
Q

signs hypokalemia

A

weakness, fatigue, muscle cramps
flaccid paralysis hyporeflexia, tetany and rhabdomyolysis
EKG shows broad T waves and U waves, ST depression and PVC

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62
Q

periodic sharp waves on EEG

A

prion disease

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63
Q

rapidly progressing dementia and myoclonus

A

prion disease

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64
Q

gradually worsening severe low back pain that is worse at night laying down and have symmetric weakness with absent DTRs early on. later develop hyperreflexia and babinski

A

spinal cord compression

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65
Q

Tx spinal cord compression

A

EM MRI
IV glucocorticoid
rad/onc or neurosurg consults

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66
Q

first line for alzheimers

A

cholinesterase inhibitors like donepezil, galantamine, rivastigmine

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67
Q

what is sympathetic opthalmia

A

immune mediated inflammation of one eye after penetrating injury to other. “uncover hidden Ag”

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68
Q

Shy Drager syndrome

A

multiple system atrophy

parkinsonism, autonomic dysfunction and widespread neurologic signs including cerebellar, pyramidal and LMN

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69
Q

patient with parkinsonism has othostatic hypotension incontinence and other ANS Sx

A

suspect shy drager

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70
Q

infant with fialure to thrive, bilateral cataracts jaundice an dhypoglycemia

A

Galactose 1 phosphate uridyl transferase deficiency aka Galactossemia

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71
Q

patient with galactossemia are at increased risk for what

A

E coli neonatal sepsis

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72
Q

gradual loss peripheral vision

A

open angle glaucoma

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73
Q

atrophy caudate

A

huntingtons

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74
Q

baby crying goes pale and passes out

A

breath holding spell, normal in 6 mo - 2 yr

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75
Q

side effect expected early on after initiation levodopa/carbidopa

A

hallucinations and dyskinesia

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76
Q

amantadine side effects

A

ankle edema and livedo reticularis

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77
Q

Wernicke encephalopathy

A

encephalopaty, ocular dysfunction, gait ataxia

from alcohol

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78
Q

Tx wernicke

A

thiamine and glucose

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79
Q

drug for trigem neuralgia

A

carbamazepine

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80
Q

prophylaxis for cluster HA

A

verapamil, lithium, and ergotamine

81
Q

treatment for acute cluster HA

A

100% O2 and subcutaneous sumatriptan

82
Q

transient pain in right UE and LE. right hemianesthesia, mild athetosis right hand
strength is preserved in all 4
lesion is where?

A

thalamus “thalamic pain phenomenon”

83
Q

Tx for migrain in children

A

supportive like laying in dark and then administration of acetominophen or NSAID

84
Q

gonococcal conjunctivitis

A

copious exudates and eyelid swelling at age 2-5

85
Q

Tx gonococcal conjunctivitis

A

hospitalization

dose of ceftriaxone or cefotaxime

86
Q

NF1 characteristics

A

cafe au lait spots, macrocephaly, feeding problems, short stature and learning disabilities

87
Q

acute ischemic stroke, hemorrhage rule out, next step?

A

fibrinolytic therapy if within 3-4.5 hours

88
Q

Leschy nyhan mutation

A

x linked recessive. hypoxanthin guanin phosphoribosyl transferase

89
Q

glucocorticoid induced myopathy

A

progressive muscle weakness and atrophy without pain

lower extremity more common

90
Q

arm helf in external rotation cannot internall rotate

A

axillary nerve damaged

91
Q

triad epidural abscess

A

fever, severe focal back pain and neuro deficits

progressive symptoms of radiculopathies and motor/sensory deficits

92
Q

Dx spinal epidural abscess

A

MRI spine with gadolinium

93
Q

Tx spinal epidural abcess

A

immediate surgical decompression

94
Q

what pathogen is assoc with guillain barre

A

Campylobacter jejuni

95
Q

high velovit injury to the high has a higher probability for what

A

globe penetration an intraocular foreign body so use fluorescein to look

96
Q

causes of delerium

A 
drugs
infection
electrolytes
metabolic derrangments
systemic illness
CNS
97
Q

Sx of facial palsy upper and lower

A

cannot do brow movements

cannot close eyes

98
Q

visual hallucinations are in what dementia

A

lewy body

99
Q

what is trachoma

A

caused by chlamydia trachomatis, cuase blindness worldwide

100
Q

sigsn trachoma

A

follicular conjunctivitis and pannus(neovascularization) in cornea

101
Q

Tx trachoma

A

topical tetracycline and oral azithromycin

102
Q

acute angle closure

A

more common in asian women
severe eye pain with halos around lights
pupil is dilated and poorly responds to light
HA with nausea and vomiting

103
Q

Tx pseudotumor cerebri

A

acetazolamide is first line

inhibits choiroid plexus carbonic anhydrase

104
Q

diffuse cortical and subcortical atrophy in temporal and parietal lobes

A

alzheimer

105
Q

Dx vasospasm post subarachnoid hemorrhage

A

CTA

106
Q

how to prevent vasospams post subarachnoid hemorrhage

A

nimodipine

107
Q

tremor in parkinsons

A

4-5 Hz. better with intention. resting tremor

108
Q

straight lines now appear wavy

A

macular degeneration

109
Q

HIV patient with ekratitis fundoscoy show pale peripheral retinal lesions and central necrosis of retina

A

Herpes simplex

110
Q

most common predisposing factor to orbital cellulitis

A

bacterial sinusitis

111
Q

signs orbital cellulitis

A

proptosis, ophthalmoplegia and diplopia

112
Q

affect of young child with meningtisi

A

regression of milestones

113
Q

most common cause lumbar spine stenosis

A

degenerative joint disease

114
Q

signs lumbar spine stenosis

A

worse when walking downhill because extends spine. weakness, senory loss, numness
confirm by MRI

115
Q

male with sudden onset red left eye with photophobia nausea and severe HA. no trauma. nonreactive mid dilated left pupil

A

acute angle closure glaucoma

116
Q

what medication can precipitate acute angle closure

A

decongestants

117
Q

trigem neuralgia is common in what population

A

women with MS

118
Q

sensory of cornea is innervated by

A

trigeminal nerve, V1

119
Q

pathogens causing brain abscesses

A

strep viridans
staph aureus
gram negative

120
Q

solitary ring enhancing lesion on brain CT with fluid collection in ethmoid sinus

A

brain abscess

121
Q

why are patients with Digeorge higher risk brain abscess

A

have the VSD which provides access to brain arterials without going through lung first, escaping lung mechanisms to rid infections and pathogens.
if vignette says child with multiple sinusitis, suspect brain abscess

122
Q

auras are indicative of what type seizure

A

focal area so partial seizure

123
Q

complex partial seizure

A

automatisms with the LOC

124
Q

partial seizure iwth secondary generalization

A

tonic clonic manifestations like diffuse muscle aches and elvated CPK

125
Q

treatment trigeminal neuralgia

A

carbamazepine

126
Q

adverse effect carbamazepine

A

aplastic anemia, need routine CBC

127
Q

Fetal alcohol syndrome characteristics

A

small palpebral fissures
smooth philtrum
thin vermilion border

can have microcephaly

128
Q

long narrow face, prominent forehead and chin
large ears
macrocephaly
macroorchidism

A

fragile X syndrome

129
Q

causes of hemiplegia in children

A

seizure, intracranial hemorrhagic, ischemic stroke, hemiplegic migraine

130
Q

Signs craniopharyngioma

A

remnants of rathke pouch
can cause bitemporal hemianopsia
can cause endocrinopathies from compression pituitary stalk
suprasellar calcified mass on imaging

131
Q

what is opthomalogic manifestation NF1

A

optic glioma

132
Q

gait distrubance with medulloblastoma

A

truncal ataxia

133
Q

bitemporal hemianopsia and decreased libido

A

likely craniopharyngioma

134
Q

Tx restless leg syndrome

A

first line is dopamine agonist pramipexole

alternate is alpha 2 delta Ca channel ligands like gabapentin

135
Q

presbyopia

A

loss of lens elasticity

needed to focus on near objects

136
Q

DM II with fatigue urinary frequency and increased blurry vision and leg cramps. all after respiratory infection. high BP. dry mucous membranes urine + glucose negative for ketones
whats causing vision blurriness?

A

hyperosmolarity from non ketotic hyperglycemia causing osmotic diuresis and dehydration

137
Q

postconcussive syndrome

A

HA confusion, amnesia, difficulty concentrating with multitasking, vertigo, mood alteration, sleep disturbance and anxiety

138
Q

side effect metoclopramide

A

dystonic reaction because it is a dopamine R antagonist

can cause agitation, tardive dyskinesia and dystonic reactions and parkinsonism

139
Q

how to counteract dystonic reaction from metoclopramide

A

benztropine or diphenhydramine

140
Q

basal ganglia hemorrhage signs

A

contralateral hemiparesis and hemisensory loss
homonoymous hemianopsia
gaze palsy

141
Q

thalamus hemorrhage signs

A

contra hemiparesis and hemi sensory
nonreactive miotic pupils
upgaze palsy
eyes deviate towards hemiparesis

142
Q

pinpoint reactive pupils. where is hemorrhage

A

pons

143
Q

most common etiology of basal ganglia hemorrhage

A

HTN vasculopathy

144
Q

best Dx acoustic neuroma

A

MRI with gadolinium

145
Q

homocystinuria

A 
intellecual disability
thrombosis
megaloblastic anemia
fair complexion
tall stature
join hyperlaxity
scoliosis
146
Q

What is mechanism of diabetic oculomotor nerve neuropathy

A

ischemic of the somatic fibers, does not affect parasympathetic so reactive to light still

147
Q

conjuctival appearance in allergic conjunctivits

A

follicular or bumpy conjunctival edema (chemosis)

148
Q

lacunar strokes affect what areas

A

basal ganglia
internal capsule
pons

149
Q

risk factor lacunar strokes

A

HTN
DM smoking, age, and high LDL
cause lipohyalinosis

150
Q

painful eye with very red sclera and opacification and ulceration of the cornea

A

contact lens assoc keratitis
usually due to pseudomonas and serratia
medical EM

151
Q

Tx pseudomonal keratitis

A

topical broad spectrum antibiotics

152
Q

Anterior cord syndrome

A

burst fracture in vertebrae
lose motor below and loss pain and temp on both sides below lesion
get MRI

153
Q

NF patient with HA nausea and vomiting. next step

A

order brain and orbital MRI

154
Q

another name for vasovagal syncope

A

neurocardiogenic

155
Q

loss of conjugate gaze

A

MLF disruption

156
Q

what meds can cause pseudotumor cerebri

A

hypervitaminosis A (acne)

157
Q

most important risk factor for stroke

A

HTN >smoking

158
Q

central cord syndrome

A

weakness in UE more than lower. selective loss of pain and temp in arms from damage to spinothalamic tract

159
Q

type of injury for central cord syndrome

A

hyperextension

160
Q

mutation in fragile X

A

CCG repeats causing abberant methylation

161
Q

what is maintained in anterior cord syndrome

A

position vibration and touch

162
Q

LP results in GBS

A

increased protein. normal everything else

163
Q

what causes decreased glucose in LP analysis

A

bacterial meningitis or TB meningitis

164
Q

what is pathology benight paroxysmal positional vertigo

A

crystalline deposits in semicircular canals that disrupt flow

165
Q

Lambert Easton

A

autoAb against voltage gated Ca Ch in presynaptic motor nerve terminal, defective release Ach

166
Q

tick borne paralysis

A

rapidly progressive ascending paralysis, can be asymmetrical and there are no sensory abnormalities and CSF is normal

167
Q

complication of untreated pseudotumor cerebri

A

blindness

168
Q

chalazion

A

painful swelling progress to nodular rubbery lesion

169
Q

recurrent chalazion, next step

A

histopath examination

170
Q

finding on patient with alcoholic cerebellar degeneration

A

gait dysfunction, truncal ataxia, nystagmus and intention tremor or dysmetria

171
Q

pain and decreased visual acuity post cataract surgery

A

postop enopthalmitis

need humor sent for culture and gram stain

172
Q

patient falling toward side of lesion

A

cerebellar tumor

173
Q

2 year old with fever, irritability and lethargy, intermittend abdominal discomfort and losing weight. firm nodular mass in right flank with no bruits
multiple calcifications in renal area and increased homovanillic and VMA

A

neuroblastoma from neural crest cells

174
Q

mets of neuroblastoma

A

bones, skull bone marrow liver, lymph nodes and skin

175
Q

fundoscopy shows zones of whitened edematous retina and disctribution of retinal arterioles

A

displaced retinal embolus

176
Q

Von Gierkes

A

glucose 6 phosphotase deficiency, type I glycogen storage disease

177
Q

Sx von gierkes

A

hypoglycemia and lactic acidosis
hyperuricemia
hyperlipidemia
doll like face, thin extremities and short stature with protuberant abdomen

178
Q

vitreous hemorrhage

A

sudden loss of vision and floaters. from diabetic retinopathy
loss of fundus details, and dark red glow

179
Q

lab value increase in Vit B12 deficiency

A

methylmalonic acid

180
Q

swelling over one cranial bone post birth with no discoloration

A

cephalohematoma

181
Q

diffuse bruised swelling of newborn scalp

A

caput succedaneum

182
Q

first line for acute angle closure glaucoma

A

mannitol IV

183
Q

how does pilocarpine decrease inraocular P

A

open canals of schlemm to allow drainage

184
Q

how dose timolol help IOP

A

decrease production aqueous humor

185
Q

most common adult onset muscular dystrophy

A

steinert disease. musc dystrophy type 1

186
Q

mutation in aduld onset musc dystrophy

A

auto dominant

CTG trinucelotide repease in DMPK gene on chrom 19q

187
Q

signs of sadult onset musc dystrophy

A

facial weakness, weak handgrip
myotonia and dysphagia
testicular atrophy

188
Q

inheritance duchenne and becker

A

x linked recessive

189
Q

onset musc dystrophy age 2-3

A

duchenne

190
Q

onset musc dystrophy age 5-15

A

becker

191
Q

girl recently brok up with bF and passes out. slightly disoriented after

A

seizure. not syncope

192
Q

what is riluzole

A

glutamate inhibitor used in ALS

193
Q

NF2 mutation

A

chrom 22. nonsense of tumor supressor gene

194
Q

wilsons disease labs

A

elevated LFTs

low ceruloplasm

195
Q

signs of wilsons

A

tremor, rigidity, depression, paranoia, catatonia

196
Q

insect bite to cheek. now both eyes swollen, no appetite, vomiting with fever. erythema and EOM restricted
tender to palpation over forehead

A

cavernous sinus thrombosis

197
Q

dacrocystitis

A

infection lacrimal sac

198
Q

changes in color perception. pain on eye movement

A

optic neuritis

199
Q

psuedodementia

A

seem severely depressed without memory loss

Step2CK (26 decks)

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